Page 119 - Clinical relevance of current materials for cranial implants

Neurological status assessment
Although the rating scale used for neurological assessment after PEEK cranioplasty was a simple ordinal scale based on subjective judgment, our results suggest a (moderate) improvement of the neurological status in several cases. An unprotected brain has to function under the atmospheric pressure which can result in a local vascular dysfunction, also known as the syndrome of the sinking scalp flap or syndrome of the trephined 3,5,6. A cranioplasty can thereby improve cerebral blood flow, resulting in an improvement of the neurological status and recovery5,6. Consequently, cranioplasty may not only be useful for cerebral protection and aesthetic improvement, but the current data also suggest that cranioplasty can result in neurological improvement.
Limitations 5 The small sample size leads to an inherent low statistical power and therefore no firm
conclusions can be drawn. No direct comparison with different cranioplasty techniques
was made. The present study also poses certain limitations due to its retrospective
nature; complications were necessarily obtained from file studies. Prospective trials are needed to further elucidate the relationship between specific risk factors and the outcome after PEEK cranioplasty.
CONCLUSION
Cranioplasty carries a significant risk of postoperative complications, not infrequently requiring reoperation. PEEK cranioplasty showed comparable complication rates to the literature reporting on cranioplasties using autologous bone grafts or allografts. Outcomes after cranial vault reconstruction using PEEK implants however compared favorably because of the advantage of re-sterilization and possibility of reuse.
Acknowledgement
The authors thank L. Dubois, MD, DDS, PhD, oral and maxillofacial surgeon, for participating in the surgical management of some of the included patients.
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